II 118TH CONGRESS 1ST SESSION S. 1497 To amend the Public Health Service Act to establish insulin assistance programs, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 9, 2023 Ms. SMITH introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend the Public Health Service Act to establish insulin assistance programs, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Emergency Access to 4 Insulin Act of 2023’’. 5 SEC. 2. INSULIN ASSISTANCE PROGRAMS. 6 (a) IN GENERAL.—Part B of title III of the Public 7 Health Service Act (42 U.S.C. 243 et seq.) is amended 8 by adding at the end the following: 9 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1497 IS ‘‘SEC. 320C. INSULIN ASSISTANCE PROGRAMS. 1 ‘‘(a) ESTABLISHMENT OF PROGRAM OF GRANTS TO 2 STATES, INDIAN TRIBES, AND TRIBAL ORGANIZA- 3 TIONS.— 4 ‘‘(1) IN GENERAL.—The Secretary shall, not 5 later than 1 year after the date of enactment of this 6 section, make grants to States, Indian tribes, and 7 tribal organizations for the purpose of carrying out 8 programs to assist eligible individuals in obtaining 9 insulin in accordance with paragraph (4). 10 ‘‘(2) GRANT AND CONTRACT AUTHORITY FOR 11 STATES, INDIAN TRIBES, AND TRIBAL ORGANIZA- 12 TIONS.— 13 ‘‘(A) IN GENERAL.—A State, Indian tribe, 14 or tribal organization receiving a grant under 15 paragraph (1) may, subject to subparagraph 16 (B), expend the grant to carry out the purpose 17 described in such paragraph through grants or 18 contracts to public or private entities, including 19 local governments. 20 ‘‘(B) CERTAIN APPLICATIONS.—If a non- 21 profit private entity and a private entity that is 22 not a nonprofit entity both submit applications 23 to a State, Indian tribe, or tribal organization 24 to receive an award of a grant or contract 25 under subparagraph (A), the State, Indian 26 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1497 IS tribe, or tribal organization shall give priority to 1 the application submitted by the nonprofit pri- 2 vate entity in any case in which the State, In- 3 dian tribe, or tribal organization determines 4 that the quality of such application is equiva- 5 lent to the quality of the application submitted 6 by the other private entity. 7 ‘‘(3) ALLOTMENT.—Each State, Indian tribe, 8 or tribal organization that applies for a grant in ac- 9 cordance with subsection (e) shall receive a grant 10 under this section in an amount that is equal to the 11 sum of— 12 ‘‘(A) a minimum amount determined by 13 the Secretary; and 14 ‘‘(B) an additional amount based on cri- 15 teria established by the Secretary, which may 16 include the ability of the State, Indian tribe, or 17 tribal organization to successfully assist individ- 18 uals in seeking eligibility for Federal or State- 19 funded programs as described in paragraph 20 (4)(A)(ii)(II). 21 ‘‘(4) PROGRAM COMPONENTS.— 22 ‘‘(A) IN GENERAL.—A State, Indian tribe, 23 or tribal organization carrying out a program 24 supported by a grant under this subsection— 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1497 IS ‘‘(i) shall use the grant funds to— 1 ‘‘(I) issue insulin cards to eligible 2 individuals in accordance with sub- 3 paragraph (B); and 4 ‘‘(II) enter into agreements with 5 pharmacies— 6 ‘‘(aa) for such pharmacies to 7 fill prescriptions for individuals 8 displaying valid insulin cards 9 that are issued in accordance 10 with subparagraph (B) at no cost 11 to such individuals; and 12 ‘‘(bb) for the State, Indian 13 tribe, or tribal organization to 14 pay such pharmacies for insulin 15 filled for a prescription described 16 in item (aa); and 17 ‘‘(ii) may use the grant funds to— 18 ‘‘(I) purchase insulin; or 19 ‘‘(II) assist individuals in seeking 20 eligibility for Federal or State-funded 21 programs which may provide coverage 22 for insulin or otherwise assist such in- 23 dividuals in obtaining insulin. 24 ‘‘(B) INSULIN CARDS.— 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1497 IS ‘‘(i) APPLICATION.—An eligible indi- 1 vidual seeking an insulin card through a 2 program supported by a grant under this 3 subsection shall submit an application to 4 the State, Indian tribe, or tribal organiza- 5 tion receiving the grant, at such time, in 6 such manner, and containing such infor- 7 mation as the State, Indian tribe, or tribal 8 organization may reasonably require for 9 purposes of this subsection, including— 10 ‘‘(I) documentation indicating 11 proof of— 12 ‘‘(aa) in the case of a grant 13 awarded to a State, residency in 14 the State; 15 ‘‘(bb) in the case of a grant 16 awarded to an Indian tribe, mem- 17 bership in the Indian tribe; or 18 ‘‘(cc) in the case of a grant 19 awarded to a tribal organization, 20 membership in the Indian tribe 21 or Indian community served by 22 the tribal organization; 23 ‘‘(II) a prescription for insulin 24 that is prescribed to the individual; 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1497 IS ‘‘(III) a statement that, to the 1 best of the individual’s knowledge, the 2 individual is an uninsured individual 3 or an underinsured individual; and 4 ‘‘(IV) if the individual is an 5 underinsured individual, the name of 6 the high-deductible health plan in 7 which the individual is enrolled and 8 any unique identifier of the plan, such 9 as a policy number. 10 ‘‘(ii) INITIAL CARD.— 11 ‘‘(I) IN GENERAL.—A State, In- 12 dian tribe, or tribal organization car- 13 rying out a program supported by a 14 grant under this subsection shall issue 15 an initial insulin card to each indi- 16 vidual that submits an application to 17 the State, Indian tribe, or tribal orga- 18 nization meeting the requirements 19 under clause (i). 20 ‘‘(II) TIMING.—A State, Indian 21 tribe, or tribal organization that re- 22 ceives an application under clause (i) 23 from an individual shall issue an ini- 24 tial insulin card to such individual not 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1497 IS later than 5 business days after re- 1 ceiving such application. 2 ‘‘(III) SUPPLY.—An initial insu- 3 lin card issued to an individual under 4 this clause shall be valid for an ap- 5 proximate 7-day supply of insulin that 6 is appropriate for the individual based 7 on the prescription for the individual 8 provided in the application under 9 clause (i) and packaging and proc- 10 essing practices for insulin. 11 ‘‘(iii) 3-MONTH CARDS.—Not later 12 than 12 business days after an individual 13 submits an application under clause (i) to 14 a State, Indian tribe, or tribal organiza- 15 tion, the State, Indian tribe, or tribal orga- 16 nization shall— 17 ‘‘(I) determine whether the indi- 18 vidual is an eligible individual; and 19 ‘‘(II) if the individual is an eligi- 20 ble individual, issue the individual an 21 insulin card that is valid for an ap- 22 proximate 90-day supply of insulin 23 that is appropriate for the individual 24 based on the prescription provided in 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 1497 IS the application under clause (i) and 1 packaging and processing practices 2 for insulin. 3 ‘‘(iv) RENEWAL OF CARDS.— 4 ‘‘(I) 3-MONTH CARDS.—An eligi- 5 ble individual that is issued an insulin 6 card under clause (iii) may apply to 7 renew such card in accordance with a 8 process established by the State, In- 9 dian tribe, or tribal organization. 10 ‘‘(II) LIMITATION.—An indi- 11 vidual that submits an application 12 under clause (i) and is denied an insu- 13 lin card under clause (ii) or (iii) may 14 not submit another application under 15 clause (i) for the 1-year period begin- 16 ning on the date on which the indi- 17 vidual is denied such card. 18 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.— 19 ‘‘(1) IN GENERAL.—The Secretary may not 20 make a grant under subsection (a) unless the State, 21 Indian tribe, or tribal organization involved agrees, 22 with respect to the costs to be incurred by the State, 23 Indian tribe, or tribal organization in carrying out 24 the purpose described in subsection (a)(1), to make 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 1497 IS available non-Federal contributions (in cash or in 1 kind under paragraph (2)) toward such costs in an 2 amount equal to not less than $1 for each $3 of 3 Federal funds provided in the grant. Such contribu- 4 tions may be made directly or through donations 5 from public or private entities. 6 ‘‘(2) DETERMINATION OF AMOUNT OF NON- 7 FEDERAL CONTRIBUTION.— 8 ‘‘(A) IN GENERAL.—Non-Federal contribu- 9 tions required in paragraph (1) may be in cash 10 or in kind, fairly evaluated, including equipment 11 or services (and excluding indirect or overhead 12 costs). Amounts provided by the Federal Gov- 13 ernment, or services assisted or subsidized to 14 any significant extent by the Federal Govern- 15 ment, may not be included in determining the 16 amount of such non-Federal contributions. 17 ‘‘(B) MAINTENANCE OF EFFORT.—In 18 making a determination of the amount of non- 19 Federal contributions for purposes of paragraph 20 (1), the Secretary may include only non-Federal 21 contributions in excess of the average amount 22 of non-Federal contributions made by the State, 23 Indian tribe, or tribal organization involved to- 24 ward the purpose described in subsection (a)(1) 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •S 1497 IS for the 2-year period preceding the first fiscal 1 year for which the State, Indian tribe, or tribal 2 organization is applying to receive a grant 3 under subsection (a). 4 ‘‘(C) INCLUSION OF RELEVANT NON-FED- 5 ERAL CONTRIBUTIONS FOR MEDICAID.—In 6 making a determination of the amount of non- 7 Federal contributions for purposes of paragraph 8 (1), the Secretary shall, subject to subpara- 9 graphs (A) and (B) of this paragraph, include 10 any non-Federal amounts expended pursuant to 11 title XIX of the Social Security Act by the 12 State, Indian tribe, or tribal organization re- 13 lated to insulin dispensed to individuals eligible 14 for medical assistance under such title. 15 ‘‘(c) ADDITIONAL REQUIRED AGREEMENTS.— 16 ‘‘(1) STATEWIDE PROVISION OF SERVICES.— 17 ‘‘(A) IN GENERAL.—The Secretary may 18 not make a grant under subsection (a) unless 19 the State, Indian tribe, or tribal organization 20 involved agrees that services and activities 21 under the grant will be made available through- 22 out the State (including availability to members 23 of any Indian tribe or tribal organization in the 24 State), Indian tribe, or tribal organization. 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •S 1497 IS ‘‘(B) WAIVER.— 1 ‘‘(i) IN GENERAL.—The Secretary 2 may waive the requirement established in 3 subparagraph (A) for a State, Indian tribe, 4 or tribal organization if the Secretary de- 5 termines that compliance by the State, In- 6 dian tribe, or tribal organization with the 7 requirement would result in an inefficient 8 allocation of resources with respect to car- 9 rying out the purpose described in sub- 10 section (a)(1). 11 ‘‘(ii) INDIAN TRIBES AND TRIBAL OR- 12 GANIZATIONS.—If an Indian tribe or tribal 13 organization is receiving a grant under 14 subsection (a) and the State in which the 15 tribe or organization is located is receiving 16 a grant under subsection (a), the require- 17 ment under subparagraph (A) for the 18 State regarding availability to the tribe or 19 organization is deemed to have been 20 waived under this subparagraph. 21 ‘‘(2) RELATIONSHIP TO ITEMS AND SERVICES 22 UNDER OTHER PROGRAMS.— 23 ‘‘(A) IN GENERAL.—The Secretary may 24 not make a grant under subsection (a) unless 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •S 1497 IS the State, Indian tribe, or tribal organization 1 involved agrees that the grant will not be ex- 2 pended to make payment for any item or serv- 3 ice to the extent that payment has been made, 4 or can reasonably be expected to be made, with 5 respect to such item or service— 6 ‘‘(i) except as provided in subpara- 7 graph (B), under any State compensation 8 program, under an insurance policy, or 9 under any Federal or State health benefits 10 program; or 11 ‘‘(ii) by an entity that provides health 12 services on a prepaid basis. 13 ‘‘(B) EXCEPTION.—The requirement under 14 subparagraph (A)(i) shall not apply with re- 15 spect to coverage under a high-deductible health 16 plan. 17 ‘‘(3) LIMITATION ON ADMINISTRATIVE EX- 18 PENSES.—The Secretary may not make a grant 19 under subsection (a) unless the State, Indian tribe, 20 or tribal organization involved agrees that not more 21 than 10 percent of the grant will be expended for 22 administrative expenses with respect to the grant. 23 ‘‘(4) RECORDS AND AUDITS.—The Secretary 24 may not make a grant under subsection (a) unless 25 VerDate Sep 11 2014 03:07 May 17, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1497.IS S1497 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •S 1497 IS the State, Indian tribe, or tribal organization in- 1 volved agrees that— 2 ‘‘(A) the State, Indian tribe, or tribal orga- 3 nization will establish such fiscal control and 4 fund accounting procedures as may be nec- 5 essary to ensure the proper disbursal of, and 6 accounting for, amounts received by the State, 7 Indian tribe, or tribal organization under such 8 subsection; 9 ‘‘(B) the State, Indian tribe, or tribal orga- 10 nization will keep such records as the Secretary 11 shall prescribe, including— 12 ‘‘(i) records that fully disc [Text truncated for display. 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